One-minute schirmer test with anesthesia

The 5-minute Schirmer test is a commonly described test for dry eye syndrome but is impractical for most ophthalmologists to perform routinely because of the 5-minute time frame. Hence, we decided to evaluate the intraindividual reliability of different wetting times of the Schirmer basal tear secretion test correlated to that of the standard 5-minute Schirmer test.

A prospective study was performed using 60 eyes of 30 patients. All patients had symptoms of dry eye syndrome. Patients were excluded if they had anatomic lid abnormalities that could interfere with the conduct of the test. The reliability of the Schirmer test at 30 seconds and 1, 2, 3, and 4 minutes was compared with that of the standard 5-minute test using the intraclass correlation coefficient (ICC).

The ICC for each eye was only moderate at 30 seconds but was high to extremely high thereafter. Specifically, at 1 minute, the ICC for right eyes was 0.938 and for left eyes was 0.817. Furthermore, 100% of patients with severe dry eye (defined as a 5-minute Schirmer test of 5.5 mm or less) had a 1-minute Schirmer test less than or equal to 2 mm. Also, 80% of patients with a moderate dry eye (defined as a 5-minute Schirmer test between 5.5 to 10 mm) had a 1-minute test between 3 to 6 mm.

Our results support the hypothesis that shorter durations of the 5-minute Schirmer test correlate highly with those of the 5-minute test. Specifically, the 1-minute test correlates highly with the 5-minute test and will make this test much more practical for ophthalmologists.